Staged imaging pathway for the evaluation of pediatric appendicitis

Area of Science:

• Pediatric Radiology
• Abdominal Imaging
• Clinical Pathways

Background:

• Computed tomography (CT) is frequently used for pediatric appendicitis, despite significant radiation exposure.
• Widespread CT use raises concerns about cumulative radiation dose in children.

Purpose of the Study:

• To assess the impact of a novel staged imaging pathway on CT utilization for pediatric appendicitis.
• To determine if this pathway maintains diagnostic accuracy while reducing radiation exposure.

Main Methods:

• A retrospective chart review compared imaging practices for appendicitis over a 12-month period before and after pathway implementation.
• Data analysis focused on CT use, diagnostic accuracy, negative appendectomy rates, and complication rates.

Main Results:

• Initial CT use decreased from 87.1% to 13.4% for appendicitis-positive evaluations and 82.6% to 9.2% for negative evaluations.
• Overall CT use dropped from 91.7% to 25.1%, avoiding CT for 350 patients.
• Negative appendectomy, missed appendicitis, and perforation rates remained statistically unchanged.

Conclusions:

• The staged imaging pathway effectively reduced CT utilization in pediatric appendicitis evaluations.
• This strategy significantly lowers radiation exposure in children without compromising diagnostic performance or safety.